Three patients with a paraneoplastic neurological syndrome: the significance of paraneoplastic antibodies

P A E Sillevis Smitt, S K L Polman, J W K de Beukelaar, R H Enting, M J van den Bent, J E Bromberg, J M Kros, H Hooijkaas

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    Abstract

    Establishing the presence of paraneoplastic antibodies is important in identifying an often severe neurological syndrome as paraneoplastic and hence directing the search for an underlying neoplasm. A paraneoplastic neurological syndrome was diagnosed in 3 patients. The first was a 64-year-old woman in whom paraneoplastic encephalomyelitis was diagnosed. The diagnosis was strongly supported by a high titre of serum anti-Hu antibodies, despite three negative biopsies from a mediastinal mass. The patient died of a non-convulsive status epilepticus; autopsy revealed not only paraneoplastic encephalomyelitis but also small-cell lung cancer. The second patient was a 55-year-old woman with metastatic breast cancer. After a three-year period of progressive neurological deterioration, a high titre of anti-CV2/CRMP5 antibodies was detected, on the basis of which the clinical syndrome was diagnosed as paraneoplastic. She received immunotherapy and her condition stabilised. The third patient, a 41-year-old man, presented with severe limbic encephalitis. Biopsy from a paraaortic mass was positive for undifferentiated carcinoma. The patient had a high titre ofanti-Ma2 antibodies and was subsequently tested positive for serum alpha-foetoprotein (AFP) and beta-human-chorionic gonadotrophin (bta-HCG). During chemotherapy for a non seminoma testicular cancer, the limbic encephalitis improved both clinically and radiologically, but the patient died as a result of the toxicity of the treatment.

    Translated title of the contributionThree patients with a paraneoplastic neurological syndrome: the significance of paraneoplastic antibodies
    Original languageDutch
    Pages (from-to)874-880
    Number of pages7
    JournalNederlands Tijdschrift voor Geneeskunde
    Volume151
    Issue number15
    Publication statusPublished - 14-Apr-2007

    Keywords

    • Adult
    • Antibodies, Neoplasm
    • Breast Neoplasms
    • Carcinoma, Small Cell
    • Female
    • Humans
    • Limbic Encephalitis
    • Lung Neoplasms
    • Male
    • Middle Aged
    • Paraneoplastic Syndromes
    • Status Epilepticus
    • Testicular Neoplasms

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